The healthcare provider (HCP) prescribes methylergonovine for a postpartum client following the birth of her third child.
The client asks the practical nurse (PN), "Why am I getting these tablets? I did not get them with my last babies.”. Which response is best for the PN to provide?
Bleeding with the delivery of this baby is more than expected, and this medication helps contract the uterus.
The HCP routinely prescribes this medication for all women who have had three or more infants.
Methylergonovine is commonly prescribed to help contract the uterus and prevent excess bleeding.
What did the HCP say about the medications during postpartum care?
The Correct Answer is A
Choice A rationale
Methylergonovine is an ergot alkaloid that directly stimulates sustained uterine contractions. This action is crucial in controlling postpartum hemorrhage by compressing blood vessels within the myometrium, thereby reducing blood loss. The observed excessive bleeding with this delivery necessitates intervention to prevent complications like hypovolemic shock. Its pharmacological effect targets smooth muscle receptors in the uterus.
Choice B rationale
Routine prescription based solely on parity (number of previous pregnancies) is not standard medical practice. Methylergonovine is administered based on clinical indication, primarily to prevent or manage postpartum hemorrhage, which is determined by factors like uterine atony or excessive bleeding, not simply the number of previous births. Unnecessary administration can lead to adverse effects.
Choice C rationale
While methylergonovine does contract the uterus and prevent excess bleeding, this response is a general statement. The best response directly addresses the client's current situation and her question about why *she* is receiving it *this time*. It is crucial to explain the specific clinical reason for her individual prescription, which in this context is likely due to the increased bleeding.
Choice D rationale
This response shifts the responsibility back to the client and does not provide the requested information. It fails to address the client's direct question about the medication's purpose in her specific situation. Providing clear and concise information is essential for client education and adherence to the treatment plan.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
Using an on-demand feeding schedule allows the newborn to feed when hungry, which is important for establishing milk supply and meeting the infant's needs. However, it does not directly provide a quantitative measure of milk intake, as duration and frequency can vary.
Choice B rationale
Counting the number of wet diapers per day is an objective and reliable indicator of adequate hydration and milk intake in a breastfed newborn. Typically, a newborn should have at least 6-8 wet diapers per 24 hours by the end of the first week of life, indicating sufficient milk consumption.
Choice C rationale
Initiating feeding on the same breast each time is incorrect. It is generally recommended to alternate breasts with each feeding or offer both breasts at each feeding to ensure equal stimulation and drainage, which helps maintain milk supply in both breasts and prevents engorgement.
Choice D rationale
Supplementing with formula between feedings is not recommended as a primary method to assess milk intake and can interfere with the establishment of a robust breastfeeding relationship. It can decrease the infant's demand for breast milk, potentially reducing the mother's milk supply and introducing allergens.
Correct Answer is D
Explanation
Choice A rationale
Changes in food selections and preparation can be a minor stressor for hospitalized toddlers, as familiar routines are disrupted. However, while dietary changes might cause some fussiness, they typically do not elicit the profound emotional distress and regression seen with more significant stressors like separation from primary caregivers.
Choice B rationale
Fear of the unknown and painful procedures is certainly a stressor for toddlers. The lack of understanding about medical interventions and the potential for discomfort can cause anxiety. However, for a toddler, the underlying fear of being abandoned by their primary attachment figures often outweighs the fear of the procedures themselves.
Choice C rationale
Unfamiliar people and strange equipment can contribute to a toddler's stress during hospitalization, as they are outside of their usual environment and routine. This can lead to feelings of insecurity and apprehension. However, the emotional impact of these elements is generally less profound than the distress caused by the absence of parents.
Choice D rationale
Separation from parents and home is the most significant stressor for hospitalized toddlers. At this developmental stage, toddlers are deeply reliant on their primary caregivers for security and comfort. Separation can trigger profound feelings of abandonment, anxiety, and lead to regression in developmental milestones.
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